Health Front: Safer Guildlines for Back Pain Care in Oregon

●The state of Oregon has now adopted new guidelines and recommendations for low back pain evaluation and treatment.

The Oregon Health Authority has collaborated with Universities and research foundations to recommend that spinal manipulation by a doctor of Chiropractic should be the first line of treatment in the first four weeks care. They also recommend that spinal adjusting as the only effective nonpharmacological treatment for low back pain. Multiple evidence based research studies have validated the efficacy of spinal adjusting for management of low back pain. The Oregon health authority concludes that all too often medical clinicians led patients down a path to surgery, steroid injections and drug addiction rather than an interdisciplinary approach.

Research of health care policy and guidelines for low back pain treatment had stated in 1994 that spinal adjusting both relieves pain and restores function, while medications (anti-inflammatory, analgesics) relieve pain but do not restore spinal function. Subsequent research has not refuted the value of spinal adjusting. It has mainly reinforced the importance of restoring spinal function without drug dependence or invasive procedures. The new guidelines and management for low back pain direct physicians towards a conservative management and interdisciplinary approach instead of drugs and surgery.

Research has pointed out that the risk-to-benefit ratio favored spinal adjusting over the medications of acetaminophen and non-steroidal anti-inflammatories. Pharmacological therapy, with its considerable downfall, will be replaced as a first line of recommended treatment for the management of low back pain, with or without leg nerve symptoms. Spinal manipulation now takes precedence as a first line of care for back conditions.

Acetaminophen (e.g., Tylenol) is the leading cause of acute liver failure in the United States, resulting in 140,000 poisoning cases, 56,000 ER visits and over a hundred deaths each year. Oregonians were unknowingly taking more than one drug product, increasing the likelihood of overdoses and poisoning. Non-steroidal ant-inflammatory drugs (NSAIDs) are the second leading cause of peptic ulcers, resulting in 100,000 hospitalizations and 17,000 deaths annually in the U.S. Oregon’s narcotic statistics reveal that in the last few years oxycodone sales increased by 866 percent, while methadone increased by 1,293 percent. Over 50 percent of all drug overdoses in Oregon are from prescription pharmaceuticals. The Oregon Health Policy Board strongly cautions physicians about drug prescriptions and implores them to consider safe spinal adjusting as a first-tier status instead of narcotics.

● Last week, California started dismantling the popular “Healthy Families” program for low income children by shifting nearly 200,000 young people into the massive Medi-Cal program. Many health advocates fear that this shift to a more limiting form of health care will disrupt proper care. By August, about 900,000 children in the “Healthy Families” program will be shifted into Medi-Cal, with all its restrictions and rationing. A consistent and primary family doctor and/or specialist will get harder to find. To avoid potential chaos created by making the change all at once, the state department of Health Care Services is dividing the move into four parts. The first group in the shift includes children who are least likely to experience any disruption in health care because they are in managed-care plans that also offer Medi-Cal coverage. The other three groups of 200,000 children each will transition on April 1st, June 1st and August 1st.

Many parents and health care advocacy groups are very concerned. Healthy Families was paying doctors 10 to 20 percent more for their fees than the discounted Medi-Cal program. Children with Type 1 diabetes that are dependent on insulin may require a need to find another specialist. Access to surgeons, dentists, optometrists and chiropractors will not be as available as it was with Healthy Families. Longer waits for appointments and clinic changes are expected. Clinician consistency is doubtful. Children’s health advocates already point out that the state sent more than 2,600 Medi-Cal cards to the wrong families in a big initial snafu. Pediatricians at Oakland’s Children’s Hospital are extremely concerned about a rush into changes. Doctors will need more time before they can enlist in a new and complex program that will probably ask them to provide on the cheap. Changing providers is a hardship on people. Trouble finding a doctor who isn’t part of a big box medical corporation will be a real concern for rural people with children.

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